Pain neuroscience education for patients with chronic pain: A scoping review from teaching-learning strategies, educational level, and cultural perspective.

OBJECTIVE: (1) To identify the characteristics of PNE programs in terms of teaching-learning strategies, session modality, content delivery format, number of sessions, total minutes and instructional support material used in patients with chronic musculoskeletal pain, (2) to describe PNE adaptations for patients with different educational levels or cultural backgrounds, and (3) to describe the influence of the patient's educational level or cultural background on the effects of PNE. METHODS: The PRISMA guideline for scoping reviews was followed. Nine databases were systematically searched up to July 8, 2023. Articles that examined clinical or psychosocial variables in adults with chronic musculoskeletal pain who received PNE were included. RESULTS: Seventy-one articles were included. Studies found benefits of PNE through passive/active teaching-learning strategies with group/individual sessions. However, PNE programs presented great heterogeneity and adaptations to PNE were poorly reported. Most studies did not consider educational level and culture in the effects of PNE. CONCLUSIONS: Despite the large number of studies on PNE and increased interest in this intervention, the educational level and culture are poorly reported in the studies. PRACTICAL IMPLICATIONS: It is recommended to use passive and/or active teaching-learning strategies provided in individual and/or group formats considering the patient's educational level and culture.

Quality of hospital care and clinical outcomes: a comparison between the Lombardy Region and the Italian national data.

Background: Improving the quality and effectiveness of healthcare is a key priority in health policy. The emergence of the COVID-19 pandemic has exerted considerable pressure on hospital networks, requiring unprecedented reorganization and restructuring actions. This study analyzed data from the Italian National Outcomes Program to compare some volumes and outcomes of public and private accredited hospitals in the Lombardy Region with national data. Study design: Observational study. Methods: A thorough examination of hospital outcomes between 2019 and 2021 was conducted, considering 45 volume indicators and 48 process and outcome indicators, comparing Lombardy with other Italian regions and public versus private accredited hospitals. Results: In 2020, Italy and Lombardy experienced a considerable reduction in overall hospital admissions, with Lombardy showing a deeper decline (21.3% compared with 16.0% in Italy). In 2021, both experienced a partial recovery, especially marked in the Lombardy region (+7.3%, compared with national data). Focusing specifically on the private sector in Lombardy, a recovery of +9.3% in hospitalization was observed. In the analysis of clinical outcomes, Lombardy outperformed the national average for 63% of the indicators in 2020 and 83.3% in 2021. Conclusions: The study shows the continuing decline in volumes compared to 2019 (pre-COVID), the excellent performance of hospitals in Lombardy and a relevant contribution for the volumes and the quality of outcomes of private accredited hospitals.

SOCIETY AND SEXUAL EDUCATION: INFLUENCES OF POLITICAL-RELIGIOUS CONSERVATISM IN THE GUIDING DOCUMENTS OF BASIC EDUCATION IN BRAZIL. / SOCIEDAD Y EDUCACIÓN SEXUAL: INFLUENCIAS DEL CONSERVADURISMO POLÍTICO-RELIGIOSO EN LOS DOCUMENTOS RECTORES DE LA ENSEÑANZA BÁSICA BRASILEÑA. / SOCIEDADE E EDUCAÇÃO SEXUAL: INFLUÊNCIAS DO CONSERVADORISMO POLÍTICO-RELIGIOSO NOS DOCUMENTOS NORTEADORES DO ENSINO BÁSICO BRASILEIRO

This work aimed to investigate the influence of conservatism on sexual education for children and adolescents in basic education schools in Brazil. It is noteworthy that there is no legislation that regulates the inclusion of sexual education in Brazilian schools, but there are guiding documents that govern teaching practices on this topic. However, these documents were affected by the conservative wave that hit the country in 2015, promoted by right-wing and evangelical conservative groups, which gained strength with the election of former President Jair Bolsonaro. The research identified the influence of conservatism on the topics of sexual freedom, sexually transmitted infections, and teenage pregnancy. A bibliographic analysis was carried out on official education documents, such as the National Common Curricular Base (BNCC), the National Education Plan (PNE), and the National Curriculum Parameters (PNC). The study allowed conclusions to be drawn from the moral perspectives highlighted in these documents, based on literature and documentary facts, and analyses that highlighted a setback in the national curriculum parameters, which deals with such an urgent and inherent issue to humanity, sexuality.

Este trabajo se fundamentó en la influencia del conservadurismo en la educación sexual para niños y adolescentes en las escuelas de enseñanza básica en Brasil. Es notorio que no existe una legislación que regule la inserción de la educación sexual en las escuelas brasileñas, sin embargo existen documentos orientadores que rigen las prácticas docentes acerca de este tema. Sin embargo, estos documentos fueron afectados por la ola conservadora que llegó al país en 2015, promovida por grupos conservadores de derecha y evangélicos, que ganaron fuerza con la elección del ex presidente Jair Bolsonaro. La investigación identificó la influencia del conservadurismo en relación a temas de libertad sexual, infecciones sexualmente transmisibles y embarazo en la adolescencia. Se realizó un análisis bibliográfico en documentos oficiales de educación, como la Base Nacional Común Curricular (BNCC), el Plan Nacional de Educación (PNE) y los Parámetros Curriculares Nacionales (PNC). El estudio permitió conclusiones de las perspectivas morales destacadas en estos documentos, basadas en la literatura y hechos documentales, y análisis que destacaron un retroceso en los parámetros curriculares nacionales, que tratan un tema tan urgente e inherente al ser humano, la sexualidad.

Este trabalho teve como fundamento a influência do conservadorismo na educação sexual para crianças e adolescentes nas escolas de ensino básico no Brasil. É notório que não existe uma legislação que regulamenta a inserção da educação sexual nas escolas brasileiras, porém existem documentos norteadores que regem as práticas docentes acerca desse tema. No entanto, esses documentos foram protegidos pela onda conservadora que consumiram o país em 2015, promovidos por grupos conservadores de direita e evangélicos, que ganharam força com a eleição do ex-presidente Jair Bolsonaro. A pesquisa identificou a influência do conservadorismo em relação aos temas de liberdade sexual, tolerantemente transmissíveis e gravidez na adolescência.Foi realizada uma análise bibliográfica em documentos oficiais da educação, como a Base Nacional Comum Curricular (BNCC), o Plano Nacional de Educação (PNE) e os Parâmetros Curriculares Nacionais (PCN). O estudo permitiu das perspectivas morais destacoudas nestes documentos, pautada pela literatura e fatos documentais, e análises que ressaltaram um retrocesso nos parâmetros curriculares nacionais, que tratam de um assunto tão urgente e inerente ao ser humano, a sexualidade.

The comparison between the effects of pain education interventions with online and face-to-face exercise and the control group received biomedical education + standardized physical therapy in patients with chronic nonspecific neck pain during COVID-19: protocol for a parallel-group randomized controlled trial.

BACKGROUND: Various psychological issues and serious health concerns during the imposed lockdown by coronavirus disease 2019 (COVID-19) have induced many changes in the treatment of patients. More effective self-management strategies through tele-rehabilitation are suggested to be applied for patients with chronic neck pain to reduce referrals to health cares and disability support through COVID-19. Also, the pain neuroscience education (PNE) approach is an educational method used by health professionals to assist patients in understanding the biology, physiology, and psychosocial factors affecting their pain experience and aligning with the cognitions and beliefs associated with pain and recurrent disability. PNE combined with tele-rehabilitation could be a new solution to encourage patients to manage their condition by themselves and increase the continuity of practice instead of face-to-face sessions. OBJECTIVE: This randomized control trial (RCT) aims to investigate the effects of PNE with online and face-to-face exercise interventions, and the control group received biomedical education + standardized physical therapy on neck pain and disability, psychological factors, and function in non-traumatic chronic neck pain. METHODS/DESIGN: Patients with non-traumatic chronic neck pain (patient-centered care and active involvement of patients and the public) will be recruited via flyers displayed in hospitals and universities to participate in an RCT with two experimental and one control group designed to investigate the effects of PNE with online and face-to-face exercise interventions, and the control group received biomedical education + standardized physical therapy on neck pain and disability, psychological factors, and function in non-traumatic chronic neck pain. The outcomes will be measured at baseline, after PNE, and after 3 months of an exercise intervention. All outcomes are presented as mean ± SD, and statistical significance was set at α level of < 0.05. The normal distribution of the variables was verified by the Kolmogorov-Smirnov test, following a descriptive analysis. DISCUSSION: It seems that PNE plus online and face-to-face exercise interventions are appropriate educational models for the treatment of patients with neck pain during COVID-19. Also, online training seems to encourage patients to continue their treatment. TRIAL REGISTRATION: Iranian Registry of Clinical Trials IRCT20150503022068N5. Registered on 09 September 2021.

Retroperitoneal hematoma post percutaneous sacral nerve evaluation: A case report.

Sacral neuromodulation is an accepted therapy for various voiding dysfunction. We report a 71-year-old male with a history of BPH post TURP and overactive bladder. He was on anticoagulants for atrial fibrillation. He underwent uneventful percutaneous sacral nerve evaluation. Five days later, he showed no improvement. Temporary lead was removed in clinic without complications. On day ten, he developed lower abdominal, and genital skin bruising. CT scan showed presacral retroperitoneal hematoma. His Hemoglobin dropped. He was admitted, managed conservatively and discharged with a stable hemoglobin. Retroperitoneal hematoma post PNE is rare. Management is conservative. Angioembolization is reserved for unstable patients.

Exploring how people with chronic pain understand their pain: a qualitative study.

OBJECTIVES: A fundamental principle of pain management is educating patients on their pain using current neuroscience. However, current pain neurophysiology education (PNE) interventions show variable success in improving pain outcomes, and may be difficult to integrate with existing understanding of pain. This study aimed to investigate how people with chronic pain understand their pain, using qualitative exploration of their conceptualisations of pain, and how this understanding accommodated, or resisted, the messages of PNE. METHODS: Twelve UK adults with chronic pain were recruited through advertisements on online pain networks. Semi-structured interviews were conducted remotely, with responses elicited using the Grid Elaboration Method (GEM) and then a PNE article. Participants' grid elaborations and responses to PNE were analysed using thematic analysis (TA). RESULTS: Three main themes were extracted from participants' grid elaborations: communicating pain, explaining pain and living with pain. These themes incorporated varied, inconsistent sub-themes: of pain as simultaneously experiential and conceptual; in the body and in the mind; diagnosable and inexplicable; manageable and insuperable. Generalised, meta-level agreement was identified in participants' PNE responses, but with doubts about its practical value. CONCLUSIONS: This study shows that people understand pain through inconsistent experiential models that may resist attempts at conceptual integration. Participants' elaborations showed diverse and dissonant conceptualisations, with experiential themes of restricted living; assault on the self; pursuit of understanding pain and abandonment of that pursuit. Responses, although unexpectedly compatible with PNE, suggested that PNE was perceived as intellectually engaging but practically inadequate. Experiential disconfirmation may be required for behavioural change inhibited by embedded fears and aversive experiences. ETHICAL COMMITTEE NUMBER: UCL REC# 17833/003.

[Health-related quality of life of children and adolescents with primary nocturnal enuresis who are undergoing therapy]. / Gesundheitsbezogene Lebensqualität von Kindern und Jugendlichen mit primärer Enuresis nocturna unter Therapie.

BACKGROUND: Primary nocturnal enuresis (PNE) affects a relevant proportion of children (10-15% at school entrance). While a significant impact on psychological well-being and self-esteem of children has been reported, the consequences for Health-Related Quality of Life (HRQoL) have been less addressed. The aim of this investigation is the analysis of HRQoL of PNE under therapy with an established questionnaire. METHODS: The KINDL­R questionnaire for HRQoL with 24 items in 6 dimensions was sent to all patients of the enuresis outpatient clinic (ages 7-17 years, minimum 3 months of therapy, no achieved dryness). Actual number of wet nights and eventual comorbidities were extracted from the clinical data. RESULTS: Of 57 questionnaires sent by mail, 47 were returned from patients and parents (82.5%). The patient results did not show a correlation between HRQoL and age, but there was a negative correlation of physical well-being and increasing age (r = -0.259, p < 0.05). A marked negative correlation was seen between bed-wetting frequency and HRQoL (r = -0.372, p < 0.05), especially in the dimensions "self-worthiness" (r = -0.399, p < 0.005) and "chronic-generic" (r = -0.383, p < 0.05). DISCUSSION: During enuresis treatment without achieved dryness, the patients did not show systematic limitation in HRQoL compared to reference populations. This is in contrast to limitations in HRQoL and self-esteem before therapy, but may possibly be explained by the correlation of this dimension with bed-wetting frequency in this study and the reported improvement through treatment in other studies. Both factors support the need and importance of adequate PNE therapy.

Effectiveness of Pain Neurophysiology Education on Musculoskeletal Pain: A Systematic Review and Meta-Analysis.

OBJECTIVES: To estimate the effectiveness and safety of Pain Neurophysiology Education (PNE) on pain, disability, and psychological distress at post-intervention and long-term (closest to twelve months after initiating the intervention) in musculoskeletal pain (MSKP). METHODS: Randomized Controlled Trials (RCT) were identified in six engines, reference lists, ClinicalTrials.gov, and by contacting key researches. Risk of bias was assessed using Cochrane Collaboration Risk of Bias Tool 2.0. Meta-analyses, using Restricted Maximum Likelihood Method, were conducted to estimate standardized mean differences (SMD) and overall quality of evidence was evaluated according to GRADE. RESULTS: In total, 18 RCTs (n = 1,585) were included. There was small to moderate effects of PNE on pain at post-intervention and long-term: SMD = -0.32 (95% confidence interval [CI]: -.58; -.05) and SMD = -0.40 (95% CI: -.78; -.03), respectively. On disability, PNE had a small effect at post-intervention: SMD = -0.17 (95% CI: -.34; -.01) but was insignificant at long-term: SMD = -0.27 (95% CI: -.59; .06). Likewise, there was a small to moderate effect on psychological distress at post-intervention: SMD = -0.36 (95% CI: -.67; -.06) but was insignificant at long-term: SMD = -0.37 (95% CI: -.75; .01). Quality of evidence was low across all outcomes. Additional analyses showed significant effects of PNE, corresponding to moderate effects, on pain and psychological distress at both time points in chronic MSKP. CONCLUSIONS: Overall quality of evidence was low, supporting PNE being safe and having small to moderate effects on pain at both time points, and on disability as well as psychological distress at post-intervention.

The Cognitive Characteristics of PNE Children with Different Genders: A Resting-State fMRI Study.

OBJECTIVES: To study the brain mechanism and behavioral performance of cognitive functional differences between children with primary nocturnal enuresis (PNE) of different genders by resting-state functional magnetic resonance imaging (rs-fMRI) and attention behavior research. METHODS: All the children participating the test were 5-11 years old including 32 PNE children (15 boys and 17 girls) and 35 normal children (16 boys and 19 girls). They respectively went through MRI scan and the data were analyzed by the method of amplitude of low frequency fluctuation (ALFF). Then continuous performance test (CPT) was done and the correct number and reaction time were recorded. The between-group variance was analyzed by two sample t-test. RESULTS: 1. fMRI: There were no obviously different brain regions of ALFF between normal boys and girls. The brain regions which had obvious differences of ALFF between PNE boys and girls were right middle frontal gyrus, left inferior parietal lobule and right posterior cerbellar lobe. And the group of PNE boys were higher than PNE girls on all the three regions (P < 0.05). 2. CPT: The reaction time of PNE and normal boys was both lower than those of girls, but there were no obvious differences on the correct number. CONCLUSION: This study found that girls with PNE performed more obvious damages on attention, executive function and working memory than boys which might be related to the fact that girls were more likely to suffer from confidence impairment due to enuresis leading to cognitive dysfunctions. The method of ALFF based on resting-state fMRI provided a new approach for studying the cognitive characteristics of PNE children.

Polynorepinephrine: state-of-the-art and perspective applications in biosensing and molecular recognition.

The polymerization of norepinephrine, and the properties of the related polymer polynorepinephrine, started to be investigated barely 9 years ago and only few works were produced so far, mainly in materials science and medicine. An unexpectedly low relevance, especially if compared with the interest toward dopamine and polydopamine, differing from norepinephrine only for a hydroxyl group and whose properties were deeply investigated and applied to an impressive number of subject areas. We show here that in some cases, norepinephrine and dopamine monomers can be exchanged without virtually affecting the experimental results. But even more interesting, the choice of norepinephrine can positively influence the properties of the final polymer. In particular, the smoother and more hydrophilic surface of polynorepinephrine may enhance cell adhesion and proliferation, increase the activity of conjugated biomolecules, and induce higher cellular uptake of nanodrugs. Moreover, polynorepinephrine presents an additional anchoring point that can be exploited for further functionalization. Nevertheless, despite its potential for bioconjugation and molecular recognition, polynorepinephrine has not yet been considered in biosensing. Here we report our feelings in terms of perspective use of polynorepinephrine as new functional monomer for biomimetic receptor development by molecular imprinting, with application in affinity biosensing. Graphical abstracts.

Single-step functionalization of poly-catecholamine nanofilms for ultra-sensitive immunosensing of ubiquitin carboxyl terminal hydrolase-L1 (UCHL-1) in spinal cord injury.

Rapid, selective, and ultra-sensitive detection of brain and spinal cord injury markers in bodily fluids is an unmet clinical need. In this work, Polycatecholamine as a rich source of amine moieties was used for single-step fabrication of ultrasensitive immunosensors for the detection of Ubiquitin carboxyl-terminal hydrolase (UCHL-1) biomarker of brain and spinal cord injuries and address the clinical need. The surface of graphene electrodes was modified by electropolymerizing aqueous solution of dopamine (DA) and norepinephrine (NE) monomers for generating polycatecholamines nanofilms on the surface of graphene screen printed electrodes (GSPE) in a single functionalization step. Amine moieties of the polymer allowed immobilization of UCHL-1 antibody on the electrode. The single-step modification of GSPE offered a simple, ultrasensitive, and stable production of immunosensors for the detection of UCHL-1. The operational range of the UCHL-1 immunosensor developed with Polynorepinephrine pNE-modified is 0.1 pg mL-1 - 105 pg mL-1 (LOD: 1.91 pg mL-1), and 1 pg mL-1 - 105 pg mL-1 (LOD: 0.70 pg mL-1) with Polydopamine (pDA) modification, satisfying the clinical range. Both pNE and pDA modified immunosensors, detected UCHL-1 spiked in phosphate buffer saline, artificial cerebrospinal fluid, and serum. Along with the sensitive detections, selective performances were recorded in the above matrices in the presence of interfering neurotransmitters GABA and Glutamate as well as glial fibrillary acidic protein (GFAP). Upon testing clinical samples of spinal cord injury patients and healthy controls, both pNE and pDA immunosensors, delivered a comparable response for UCHL-1, thereby, making immunosensors useful for clinical settings.

The role of the neurometer CPT/C in sacral neuromodulation.

OBJECTIVE: The aim of the current research project was to study the role of the Neurometer® as a tool to predict responders to sacral neuromodulation therapy (SNM). MATERIAL AND METHODS: This was a prospective, open study in male and female patients, aged 18 and over with voiding dysfunction [non-obstructive retention and/or frequency/ urgency syndrome]. The first group underwent a screening test to evaluate percutaneous nerve functions (PNE) and to determine whether they are candidates for SNM with the InterStim®. Prior to PNE testing, all patients were evaluated with the pain tolerance test (PTT) using the electro-diagnostic Neurometer® CPT/C device. An InterStim® implant was placed in patients who were responders to PNE testing underwent. On the other hand, non-responders underwent a staged implant placement. The second group consisted of patients who already had InterStim® implanted for voiding dysfunction. During the routine office follow-up, the patients implanted with Interstim® underwent a PTT using the Neurometer® CPT/C device. All the testing using the Neurometer CPT/C was performed on the day of the PNE for the first group, and the day of the routine follow-up visit for the second group. All of the results for the Neurometer® testing were kept blinded from the PNE results, and those of the outcome of the follow-up visit. The study received approval by the Research Ethics Board of the University Health Network (No. 14-8196). RESULTS: We recruited a total of 123 patients. The results presented here include 110 patients who completed the study, 48 of whom were in the first group, and 62 in the second group. The statistical analysis used was as follows: Group 1: Simple linear regression analysis and the linear discriminate analysis were preformed. It was found that for patients without the InterStim® implant with a combined CPT/CPD of 800 and above, the Neurometer® could predict the test screening results with an accuracy of 71%. Group 2: Same analysis and tests were conducted for patients with the InterStim® implant, and the results showed that if the patient had a combined CPT/CPD of 600 and above, the Neurometer® could predict the patients satisfaction or dissatisfaction with an accuracy of 72%. CONCLUSION: Neurometer® may play a role in predicting test trial positive responders and patient satisfaction after the placement of InterStim® implant.

Sacral neuromodulation for faecal incontinence following obstetric sphincter injury - outcome of percutaneous nerve evaluation.

AIM: The purpose of this study was to assess the efficacy of percutaneous nerve evaluation (PNE) in women with faecal incontinence (FI) following obstetric anal sphincter injury and to relate the outcomes to baseline factors, with special emphasis on the extent of the sphincter defect. METHOD: This was a prospective study at a tertiary colorectal referral unit at the University Hospital of North Norway conducted from 2012 to 2014. Sixty-three women underwent a 3-week PNE using a tined lead and the Verify® external neurostimulator. The primary outcome was efficacy, defined as the percentage reduction in weekly FI episodes, and patients with a reduction of 50% or more were defined as responders. Baseline factors affecting the primary outcome were explored. Sphincter defects were classified with a validated three-dimensional endoanal ultrasound defect score. RESULTS: Fifty-six (89%) of the 63 women were responders with a reduction in weekly FI episodes of 94.5%, from a median (interquartile range) of 4.8 (2.0-11.0) to 0.5 (0-2.0) (P < 0.001). Twenty-nine (52%) reported no weekly FI episodes, and urgency episodes disappeared in 18 (32%). In the multivariable linear regression model, efficacy was related to concomitant urinary incontinence (P = 0.04), body mass index (BMI) (P = 0.03) and pain during PNE (P = 0.046) but not to the extent of the sphincter defect (P = 0.1). Responders had a higher St Mark's score than nonresponders (P = 0.046). CONCLUSIONS: The vast majority of women had successful PNE tests. Responders had higher baseline St Mark's scores than nonresponders. Efficacy was related to concomitant urinary incontinence, BMI and pain, not to the extent of the sphincter defect.

Specific Tips for General Controversies in Sacral Neuromodulation.

The field of Sacral Neuromodulation is continually evolving and still in its infancy. Common dilemmas experienced with this therapy will be discussed in this article, including ways to avoid and manage them. The focus will be on test evaluations performed with either peripheral nerve evaluation (PNE) or staged procedure, the clinical effectiveness and safety of unilateral versus bilateral test stimulation for both the PNE and staged procedures, and best methods to determine the success of the trial phase. We will also discuss how to deal with the problem of declining efficacy of the device over time. The article presents a discussion on future technological innovations to enhance techniques and mode of positioning and use of leads, which along with a refined understanding of how neuromodulation is effective for different problems, will lead to better outcomes.

Psycho-neuro-endocrine-immune mechanisms of action of yoga in type II diabetes.

Yoga has been found to benefit all the components of health viz. physical, mental, social and spiritual well being by incorporating a wide variety of practices. Pathophysiology of Type II DM and co-morbidities in Type II DM has been correlated with stress mechanisms. Stress suppresses body's immune system and neuro-humoral actions thereby aff ecting normal psychological state. It would not be wrong to state that correlation of diabetes with stress, anxiety and other psychological factors are bidirectional and lead to difficulty in understanding the interrelated mechanisms. Type II DM cannot be understood in isolation with psychological factors such as stress, anxiety and depression, neuro-endocrine and immunological factors. There is no review which tries to understand these mechanisms exclusively. The present literature review aims to understand interrelated Psycho-Neuro-Endocrine and Immunological mechanisms of action of Yoga in Type II Diabetes Mellitus. Published literature concerning mechanisms of action of Yoga in Type II DM emphasizing psycho-neuro-endocrine or immunological relations was retrieved from Pubmed using key words yoga, Type II diabetes mellitus, psychological, neural, endocrine, immune and mechanism of action. Those studies which explained the psycho-neuroendocrine and immune mechanisms of action of yoga were included and rest were excluded. Although primary aim of this study is to explain these mechanisms in Type II DM, some studies in non-diabetic population which had a similar pathway of stress mechanism was included because many insightful studies were available in that area. Search was conducted using terms yoga OR yogic AND diabetes OR diabetic IN title OR abstract for English articles. Of the 89 articles, we excluded non-English articles (22), editorials (20) and letters to editor (10). 37 studies were considered for this review. The postulated mechanism of action of yoga is through parasympathetic activation and the associated anti stress mechanism. It reduces perceived stress and HPA axis activation thereby improving overall metabolic and psychological profiles, increasing insulin sensitivity, and improving glucose tolerance and lipid metabolism. Yoga has positive effects on immune system of diabetics.- Overall, Type II DM is influenced by psycho-neuro-endocrine and immune mechanisms where Yoga has important positive role in combating stressors and improving these systems to regain health.

Significant relationships among frost tolerance and net photosynthetic rate, water use efficiency and dehydrin accumulation in cold-treated winter oilseed rapes.

Five winter oilseed rape cultivars (Benefit, Californium, Cortes, Ladoga, Navajo) were subjected to 30 days of cold treatment (4 °C) to examine the effect of cold on acquired frost tolerance (FT), dehydrin (DHN) content, and photosynthesis-related parameters. The main aim of this study was to determine whether there are relationships between FT (expressed as LT50 values) and the other parameters measured in the cultivars. While the cultivar Benefit accumulated two types of DHNs (D45 and D35), the other cultivars accumulated three additional DHNs (D97, D47, and D37). The similar-sized DHNs (D45 and D47) were the most abundant; the others exhibited significantly lower accumulations. The highest correlations were detected between LT50 and DHN accumulation (r=-0.815), intrinsic water use efficiency (WUEi; r=-0.643), net photosynthetic rate (r=-0.628), stomatal conductance (r=0.511), and intracellular/intercellular CO2 concentration (r=0.505). Those cultivars that exhibited higher Pn rate in cold (and further a significant increase in WUEi) had higher levels of DHNs and also higher FT. No significant correlation was observed between LT50 and E, PRI, or NDVI. Overall, we have shown the selected physiological parameters to be able to distinguish different FT cultivars of winter oilseed rape.

Sacral neuromodulation in patients with idiopathic overactive bladder after initial botulinum toxin therapy.

PURPOSE: We evaluated whether patients with overactive bladder and incontinence who discontinued intravesical botulinum toxin therapy can be successfully treated with sacral neuromodulation. MATERIALS AND METHODS: All patients who were referred to our center after discontinuation of botulinum toxin-A between 2005 and 2010 were included in this observational study. All patients underwent test stimulation with sacral neuromodulation and were evaluated with voiding diaries. Success was defined as more than 50% improvement in leakage episodes. Successful test stimulation was subsequently followed by a definitive implant. Patient satisfaction with sacral neuromodulation therapy was evaluated 1 year after the definitive implant. RESULTS: A total of 20 patients were included in the study. Of these patients 17 (85%) had discontinued botulinum toxin-A because of lack of efficacy and 3 had been treated successfully with botulinum toxin-A but requested a more permanent solution. The mean interval between the botulinum toxin-A and the sacral neuromodulation test stimulation was 23 months. In 14 patients (70%) the test stimulation was successful and they received a definitive implant. Of the 14 patients 5 even showed a decrease of greater than 90% in leakage episodes. One year after implantation 11 patients (79%) were satisfied with the sacral neuromodulation treatment. CONCLUSIONS: Despite the small sample size, this study indicates that patients who are dissatisfied with or in whom botulinum toxin-A treatment fails can respond successfully to sacral neuromodulation. The success rate of the test stimulation was comparable to that of patients who have never been treated with botulinum toxin-A. The 1-year satisfaction rate was comparable that of patients without a history of botulinum toxin-A treatment.

Psychosocial factors and hematopoietic stem cell transplantation: potential biobehavioral pathways.

While psychosocial factors are known to affect cancer progression via biobehavioral pathways in many patient populations, these relationships remain largely unexplored in hematopoietic stem cell transplant (HCT) patients. The purpose of this paper is to critically review the literature regarding psychosocial and endocrine/immune aspects of HCT, with an emphasis on exploring pathways that may mediate the associations between psychosocial factors and disease outcomes. These include the roles of catecholamines, glucocorticoids, inflammation, vascular endothelial growth factor (VEGF), immune reconstitution and infectious susceptibility, as well as the new opportunities available in genomics research. We also discuss the implications for potential immunomodulating psychosocial interventions. Elucidating the biological pathways that account for the associations between psychosocial factors and clinical course could ultimately lead to improved outcomes for this psychologically and immunologically vulnerable population.